Valerie Jones MD

GME Reform to Meet
the Nation’s Health Needs
By Suzanne Allen, MD
Vice Dean for Academic, Rural and Regional Affairs,
UW School of Medicine
The University of Washington School
of Medicine (UWSOM) is committed to
exemplary graduate medical education
(GME). Each year ~1600 residents
and fellows train in GME programs in
Washington. Through initiatives to bring
together thought and practice leaders we
are making significant strides to improve
GME for our region and beyond.
The UWSOM has held a GME Summit
Byron Joyner
every other year for the last six years. We
recently held the fourth summit, co-hosted
by UWSOM and the Josiah Macy Foundation, in Spokane. Byron
Joyner, M.D., MPA, Vice Dean for Graduate Medical Education and
Designated Institution Official, presented “GME Reform: A History
of Mandates & Moving Targets.” His session shared where medical
education began in the U.S., and how the first standards set early in
the 20th century still apply to medical education today.
SETTING STANDARDS
In 1910, Abraham Flexner, the father of standards in medical
education – a triumvirate of research, teaching and patient care,
noted that, “For medical education to flourish from one generation
to the next, it has to reconfigure itself in response to changing
scientific, social, and economic circumstances.”
This could not be truer today, more than 100 years later.
Despite this early vision of the need for medical education to
progress, this has proven to be difficult as economics, technologies
and demographics continue to change and evolve, and more
rapidly today than ever before.
PERENNIAL PROBLEMS
Although some issues that date back to the beginning are still
concerns: keeping up with advances in technology, transparency
and accountability, and the geographic maldistribution of physicians,
current external pressures for medical education reform include:
• Changing public expectations
• CMS payments being tied to outcomes
• Changing from circumstantial to intentional practice in residency
education by using six core competencies
OIM REPORT 2014
In 2014 an expert committee formed by the IOM released
“Graduate Medical Education That Meets the Nation’s Health
Needs” – a report that outlines proposed solutions to address
current deficiencies in GME and better shape the physician
workforce of the future. Recommendations from the report include:
• Incentivize a better workforce
• Build a GME policy to standardize hospital practices
• Establish a GME Center within CMS to manage operational
aspects of GME funding and collect and report on data to ensure
transparency and more equal distribution of GME funds
• Modernize Medicare GME payment methodology
• Medicaid GME funding should be each state’s domain
Going back to 1910 and Flexner’s prescient statement that
medical education needs to keep up with change, the future
of medical education, not solely GME, requires standardization
to bring efficiency, quality and patient safety to our population.
Individualization in the learning process, flexibility in rotations,
integration in care teams, maintaining professional identity to lead
the care teams, and promoting life-long inquiry to keep up with new
technologies, methodologies and treatments are all important parts
of continuous improvement in medical education.
GOING FORWARD
Dr. Joyner noted that, as we move forward, it is important to see
that the various agencies, accrediting bodies and stakeholders are
all interested in achieving the same outcome: quality, resourceconscious
patient care, excellence in medical education and
intentional practices that measure verifiable outcomes for the public.
As we move forward with GME reforms, it’s important to note
that the solutions need advocates: politicians and physicians,
patients and nurses, medical students and residents all need
to come together in support of the future of our individual and
collective healthcare. n
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The Message | May 2016 | 9